Thoraxchirurgie, vaskulare Chirurgie最新文献

A case of left-ventricular-right-atrial septal defect secundary to blunt chest trauma is described. The etiology of this type of septal defect, e. g. congenital, following aortic and mitral valve replacement, endocarditis and trauma, is discussed. Early defect closure is recommended in the presence of significant shunt volume.

In 53 patients with mitral- or aortic-mitral valve disease, the content of ATP and lactate of the papillary muscles resected at the time of valve replacement was investigated at the beginning of ischemic arrest and at the time of reperfusion. Profound body hypothermia (25 degrees C) and injection cardioplegia using magnesium-aspartate-procaine were applied for myocardial protection. In hypertrophic papillary muscles the myocardial ATP content decreased at a slower rate (ATP decay 12% of the initial value after 60 minutes of ischemia) than in normal papillary muscles obtained from patients with isolated mitral stenosis (ATP decay 33% of the initial value after 40 minutes of ischemia). 20% of the patients required temporary inotropic circulatory support postoperatively for 12 to 88 hours. The ATP content of the papillary muscles of these patients differed only little from those, in who no myocardial failure occurred. However the myocardial lactate levels were higher in patients in whom a low cardiac output state evolved.

A case of a 66 year old patient with multiple injuries is reported. A combination of conventional trauma treatment and percutaneous transluminal angioplasty (PTR) of a segmented superficial femoral artery occlusion prevented leg amputation. When the patient died 8 weeks later from trauma sequelae the successful recanalization was demonstrated in histopathology investigation. It is concluded that PTR is an ideal accessory to the present therapeutic spectrum in vascular surgery.

Hemodynamic parameters were measured in 80 unselected patients prior to cardiopulmonary bypass for a variety of a operative procedures. Isovolemic blood withdrawel up to 24.7 ml/kg or 10 gms% and 30% hematocrit during sternotomy using ACD blood storage containers was carried out prior to bypass. Moderate hemodilution during bypass with postbypass autologous blood transfusion resulted in 60% of the study group not requiring homologous blood. The mean post-operative blood loss in this group was 245 ml. The remaining 40% received up to 1550 ml homologous blood with 820 ml mean post-operative blood loss. Omission or reduction of homologous blood requirement decreases the risk of shock lung, saves clotting factors and reduces strain on blood banking facilities.

Three cases of right ventricular perforation and acute pericardial tamponade during transvenous pacemaker implantation and one case of chronic electrode penetration are reported. Successful repair was achieved via pericardiotomy in all cases with acute tamponade. Fragility of the myocardium in the elderly is considered to be the major reason for this complication which may occur despite the use of flexible electrodes and correct surgical technique. The relatively small intervention of inferior pericardiotomy appears to be the therapy of choice in case of tamponade. This approach should be feasible when transvenous pacemakers are implanted. Immediate availability of general anesthesia and postoperative intensive care appears to be manatory.

This is a case report of a 75 year old man who sustained a longitudinal rupture of the aortic arch in addition to cerebral and extremity trauma following a traffic accident. An emergency operation without the use of the heart-lung-machine could not save the patient's life. Possible mechanisms leading to this unusual damage to the aortic arch are discussed.

In a study of postoperative psychosis after open heart surgery three psychopathological syndromes were identified which had different psychological predictors. Predictors of postoperative emotional disturbances are family problems and the lack of plans for the future, whereas patients with postoperative disorientations seem to have difficulties in their jobs and therefore feel distressed preoperatively. Predictors of the paranoid syndrome after the operation are: a high degree of fear in awaiting the operation and little confidence in the doctors. The social surroundings of these patients are often unstable and although they have no precise plans for the future they object to start working again after operation.

A case of a dissecting aneurysm of the splenic artery is presented. Although aneurysms of the splenic artery are common, a dissecting aneurysm has been mentioned infrequently in the available literature. Clinical aspects, confirmation of the diagnosis by celiac arteriography and surgical therapy are described. The pathogenesis is discussed briefly. The necessity of clinical awareness in cases of obscure abdominal pain is emphasized.

Right ventriculotomy with extracorporeal circulation was used for removal of an infected transvenous pacemaker electrode which was firmly attached to the myocardium in a patient with septicemia. Alternative methods and suggestions to prohibit electrode incarceration are discussed.

Acute stenosis of a Hancock bioprosthesis in mitral position was found eight months after surgery and three months following septic periproctitic abscess in a 59 year old woman. Echocardiography revealed almost complete valve obstruction by thrombus formation: unusual dense and inhomogenous structures between the anterior and posterior stent echos of the prosthesis were seen in systole as well as in diastole. Echocardiography appears to be a useful non-invasive method for detection of the rare thrombotic complications in Hancock bioprostheses.