Thoraxchirurgie, vaskulare Chirurgie最新文献

Eight patients with recurrent of spontaneous pneumothorax were re-examined sixteen months or more after a total parietal pleurectomy had been carried out. This re-examination included: 1. Detailed case history with emphasis on physical performance; 2. clinical findings; 3. Thorax x-ray at two planes; 4. Lungscintigraphy; 5. Spirometry. Following parietal pleurectomy, none of the patients exhibited any functional disturbance worthy of mention. This operative technique, perhaps modified as a partial parietal pleurectomy, can be recommended at this time as the method of choice for treating recurrent spontaneous pneumothorax.

The following problems are discussed as the result of an own investigation done with 150 patients after cardiac surgery: 1. the differences in incidence of cerebral complications understood as 2. a probleme of qualitatively different psychopathological and neurological syndromes. 3. Causes and relationship between the clinical stages of heart-disease and neuropsychiatric complications with special regard to the question 4. congenital heart-disease versus aquired heart-disease. 5. The role of extracorporeal circulation. 6. Remarks on the role of microembolism associated with open cardiac surgery. 7. Hereditary factors as the cause for specific psychopathological reactions.

In 1976 4 patients with Ebstein's disease underwent surgical repair. In one patient (22 yrs.) the tricuspid valve leaflets were suitable for reconstructive surgery using Hardys method in addition to De Vegas annuloplasty. In the other three cases (17, 29, 51 yrs. old) excision of the malformed tricuspid valve was necessary, and porcine heterografts of greatest possible diameter were implanted. Three patients improved considerably 9 months postoperatively. The fourth patient, a 51 years old woman, died 2 days postoperatively on cardiac failure. From our own results and based upon reports from the literature we conclude that reconstructive surgery of the tricuspid valve should be preferred to replacement. If valve replacement is necessary, bioprostheses ought to be used. At the age of 15 to 40 years, surgical repair seems to have the best prognosis in patients with Ebstein's malformation.

Preoperative mediastinal angiography, as a simple method, shows alterations of pulmonary and venous mediastinal circulation. It enables the surgeon to evaluate the operability of malignant thoracic neoplasms without performance of other diagnostic procedure with a higher rate of complications, e.g. mediastinoscopy or explorative thoractomy.

The peak systolic pressure ratio PRV/PLV of the right and left ventricle after correction of the outflow tract (OFT) in Tetralogy of Fallot (TF) yields reliable dates about the efficiency of the outflowtract correction and the probability of survival. In 110 patients (2 to 57 years) the ratio after correction PRV/PLV was measured and compared with different methods of reconstruction of the OFT. Infundibulectomy (54) pericard-patch insertion across the pulmonary valve ring (43) and a valve bearing Hancock-Conduit (13) were used. To calculate the statistical differences the U-test according to Wilcoxon, Whitney, Mann was applied on the 95% level. Moreover the pulmonary insufficiency (PI) was evaluated in 60 patients within 15 to 60 days, after correction with a videodensitometric method. There is no PI after use of a valve bearing Hancock-Conduit. In severe TF a valve bearing Hancock-Conduit is hemodynamically superior to a pericard-patchreconstruction of OFT to relief right ventricular hypertension, particularly if hypoplasia of pulmonary vessels and pulmonary vascular disease after shunt-operation is present.

17 patients, who underwent open heart procedures, were examined during and after standardized exercises at the first, second and third postoperative day. At 10 defined time intervals the following parameters were measured: arterial blood pressure, right and left atrial pressure and in the pulmonary artery, arterial and venous blood gases and cardiac output by thermodilution. Oxygen consumption and cardiac index were calculated. The results show that the majority of patients after open heart surgery are well able to adjust to additional work load even early postoperatively.

X-rays in different planes, roentgenisation, tomograms and not so often the clinical symptoms today are still responsible for the diagnosis. Mediastinoscopy and lateral mediastinoscopy very often ensure the diagnosis and dignity of the tumor. From 1956 to 1976 948 patients at our clinic were operated because of a mediastinal tumor. In 67 or 7% it was a thymic tumor. With thymic hyperplasia, thymoms and cysts of the thymic gland the survival time after operation was hardly reduced. The prognosis of the malign tumors of the thymic gland was bad with or without ray-treatment. By thymectomia 43% of the patients with myasthenia showed a good recovery.

The coincidence of pulmonary hypertension and pulmonary vascular disease was investigated in 186 infants and children with congenital heart disease and left to right shunts. The correlation between pulmonary hypertension and pulmonary vasculopathy was highly significant. Hemodynamic pulmonary hypertension is completely suppressed by early pulmonary artery banding or total correction. Even pulmonary vascular alterations can be reversed by these measures.