Thoraxchirurgie, vaskulare Chirurgie最新文献

In a 42 year old woman a left coronary artery to pulmonary artery fistula was proved by catheterization and coronary angiography. During this investigations a right femoral hernia became symptomatic, and surgical correction was carried out. Three days postoperatively a massive pulmonary embolism occurred causing shock and fibrillation of the heart. After intubation the patient was brought to the operating theatre under external massage, and a pulmonary embolectomy using ECC was performed. The fistula in the main pulmonary artery was closed by suture. The vascular convolute was left in place. A primarily additional ligature of the fistula artery at the starting point was reopened because of a failing right ventricle under the assumption of a possible partial vascular supply of the right ventricular myocardium which could not be proved.

The cystic adventitial degeneration of peripheral blood vessels is a rare lesion with unknown etiology and pathogenesis. The lesions are most frequent with a predominantly unilateral manifestation in the popliteal artery. The own observations included a rare affection of the radial artery. The literature relating to this condition has been reviewed. Etiology and histogenesis of the arterial alterations have been discussed.

Hemodynamic studies were performed in 6 normal individuals, 8 patients with severe obstruction (more than 85% stenosis) of the left anterior descending coronary artery (LAD), 10 patients with patent LAD grafts and 4 patients with stenosed or occluded LAD grafts. All patients were suffering from stable angina before operation. Monoplane ventriculograms and left ventricular pressure determinations were carried out at rest and immediately after ventricular pacing (170/min.). Anterior wall motion was determined from half-diameter shortening and ejection fraction was calculated using the area-length method. Heart rate and left ventricular systolic pressure were comparable in all 4 groups at rest and after pacing. Normal individuals and patients with patent grafts to the LAD showed no significant change of anterior wall motion, ejection fraction and left ventricular enddiastolic pressure after pacing as compared to rest. Patients with LAD stenosis showed a significant decrease of anterior wall motion, of ejection fraction and an increase of left ventricular end-diastolic pressure. Patients with graft failure revealed a drastic though not significant decrease of anterior wall motion. Decrease of ejection fraction and increase of left ventricular end-diastolic pressure were significant. Thus, in patients with stable angina and severe coronary stenosis regional and total left ventricular function may well be maintained at rest but become severely impaired after pacing. Successful revascularization abolishes this ischemic response.

Peripheral nerve injuries may complicate extracranial vascular surgery. Pareses of the recurrent and hypoglossal nerves are clinically important. The nervus laryngeus superior, the ramus marginalis mandibulae of the facial nerve and the brachial plexus may be involved. Horner's syndrom indicating damage of sympathetic fibers may also appear. Lesions of the glossopharyngeal, vagus and phrenic nerves are rather seldom.

133 patients with inflammatory or tumorous metastases of the thoracic spine were operated upon within the last 11 years. Radical removal of inflammatory lesions with consecutive corticalis-spongiosa-plasty, taken from the christa pelvis, and chemotherapy are a therapeutical unit. Excision of the tumor with supplement bone grafting or "Pallacosplombe" and stabilization according to the principals of osteosynthesis are rewarding in individual cases. Four out of nine tumor patients survived two years after surgery.

In an isolated dog heart preparation the influence of normothermic ischemic arrest and recovery of the ventricular function during the period of post-ischemic reperfusion were investigated. If ischemic arrest has caused a depression of ventricular function, the functional recovery of the myocardium cannot be improved significantly by a prolonged reperfusion of the empty beating heart.

A case of late complication after operative correction of a valvular pulmonary stenosis is reported. Chronic pulmonary embolism secondary to bacterial endocarditis situated opposite to an uncorrected small ventricular septal defect in the right ventricle caused arrosion of the pulmonary artery and subsequent severe fatal bronchial hemorrhage. The relation between VSD and bacterial endocarditis and the surgical consequences are discussed.

A 15-year-old female was treated with ECMO for acute respiratory insufficiency after severe aspiration. During 81 hours perfusion in V-A-technique even distribution of the artificially oxygenated blood was achieved by supravalvular position of the aortic cannula, which had been advanced to this position with a Ducor-Angiographycatheter. Without any improvement of the lung disease the treatment was terminated after cerebral damage due to toxic edema became evident.