Thoraxchirurgie, vaskulare Chirurgie最新文献

From 1976 to 1977 308 patients were treated with multiple aorto-coronary vein-bypass. Fiftytwo patients receiving sequential bypasses were compared with 256 patients in whom conventional multiple anastomoses were performed. The rate of postoperative bypass failure did not differ significantly in the two types of anastomoses: 16 per cent in sequential as compared to 18 per cent in conventional bypass. In both cases the circumflex-system was afflicted by bypass failure more frequently (20 per cent each). The practical and theoretical advantages and disadvantages of the two procedures are discussed. Sequential aortocoronary vein-bypass is considered the method of choice for certain combinations of coronary stenoses and also if an adequate length of vein can not be obtained.

The simple method of transarterial Xero-Arteriography and its indications are described. This investigation provides useful information in angiography of the extremities. The main advantages are: small risk, investigation of ambulatory and bedridden patients.

Analysis of results which have been obtained by interruption of the inferior vena cava for prevention of recurrent pulmonary emboli. The incidence of recurren emboli by means of the 3 possible methods ligature, plication and intraluminal filter is 6%, 5% or 2%. The incidence of fatal pulmonary emboli is 2%, 1% or 0,5%. There are no studies which do compare the effectiveness of operative procedures with the drug prevention. Both the operative and the drug prevention are not without mortality. Interruption of the inferior vena cava for the prevention of recurrent pulmonary emboli should be carried out in exceptional situations only as possibility of failure of anticoagulation.

A case of spontaneous lysis of pulmonary embolism during pulmonary arteriography is reported. Moreover diagnostical and therapeutical problems are discussed, especially with regard to operative intervention in cases of discrepancy between symptoms and angiographical findings.

Our methods of myocardial protection are demonstrated in 846 patients subjected to open heart surgery for correction of congenital heart disease. They include body hypothermia and injection cardioplegia using magnesium-asparate-procaine. The spectrum of myocardial protection reaches from normothermia without cardioplegic arrest during short periods of extracorporeal circulation to profound body hypothermia with multiple injections of the cardioplegic solution in complex cardiac malformations. The results in 586 patients with left to right shunt, 140 patients with cyanotic cardiac malformations and 120 patients with congenital valve lesions are presented. Attention is directed to possible negative sequelae of overdosage of magnesium-asparate.

3 cases of coronary reoperations are described in which a leftsided thoracotomy offered considerable advantages. This approach is recommended for certain types of reoperations on the left coronary system.

Experiments with large, non-inbred animals yield no reliable evidence in the antigenicity of heart valves. With inbred strains of rats, however, it is possible to obtain evidence on the immunological reactions of heart valve leaflet transplants. Our experiments were undertaken on the inbred rat strains (CDR, LEW, CAP and BD5, using combinations as follows: syngeneic strain combination (CDF leads to CDF), weakly allogenic (RtH-1-identical) strain cimbination (LEW leads to CDF), strongly allogeneic (RtH-1-incompatible) strain combination (CAP leads to CDF). Strain BD5 was used for the control skin grafts. Either one or two heart valve leaflets were heterotopically intra-aortally transplanted. Sensitization was verified humorally by transplantation antibody titers and cellularly by subsequent donorspecific skin transplants. The following results were achieved: Allogeneic heart valve leaflets are antigenic. Intravascular grafting of one heart valve leaflet induces the same degree of sensitization as the grafting of two leaflets. In the RtH-1-identical system, sensitization is revealed only by subsequent skin grafting, whereas in the RtH-1-incompatible system, sensitization is humorally demonstrated as well. This indicates that in heart valve leaflet transplantation cellmediated reactivity is a more sensitive indicator than the humoral one. The greater the immunological difference is, the clearer the sensitization will be. In the strongly allogeneic system, the sensitization is even demonstrated humorally; skin grafts are rejected as "white grafts". Improved long-term results may be expected in allogeneic vital heart valve transplants if consideration is given to the HLA compatibility between donor and recipient; the appearance of delayed insufficiency could be greatly lessened or even deferred.

Bronchogenic cysts usually are easily recognized and treated. On occasion they can present problems in diagnosis or management. We have experienced four such cases. A two month old infant whose cyst drained transbronchially during induction of anesthesia; a nine month old infant with preoperative respiratory obstructive signs; an adult with preoperative respiratory obstruction and acute severe respiratory distress during positioning for thoracotomy; and a newborn with an opacified hemithorax associated with retained fetal pulmonary fluid. Awareness of these unusual problems with bronchogenic cysts allows for promt and accurate management and avoids delays and possible complications.

In 20 patients, suffering from various diseases, the extent of haemolysis and the correlation between the rate of haemolysis and various mechanisms of erythrocyte damage in the course of open heart surgery was studied. We investigated haemotological parameters, electrolytes, lactate dehydrogenase before, and 1, 3, 5, and 7 days after operation. Besides free haemoglobin, haptoglobin and haemopexin were determined 5 and 15 minutes after starting perfusior with the heart-lung machine and after finishing. The best index of haemolysis was free haemoglobin in the serum. With increasing duration of perfusion the rate of haemolysis increased. Compensating mechanisms were postoperative increase of haptoglobin and haemopexin.

55 of 59 patients with artial septal defect, who had been operated in adult age, were examined postoperatively. The mean time interval from the operation was 43,8 months. Two patients had died immediately after the operation; there were no late deaths. The majority of the reexamined subjects was free of symptoms, in no case was there congestive heart failure. Persistence of postoperative symptoms increased with increasing age at the time of operation, but only up to the fourth decade of life. In 26 cases hemodynamics were examined. Mean pulmonary arterial pressure was normal at rest and during a slight ergometric load. In 5 patients there was moderate pulmonary hypertension. In 8 subjects there was minimal, in one patient moderate increase of pulmonary vascular resistance. Heartsize in chest roentgenogramm was increased in about 25% of cases, in more than 50% the pulmonary vessels were accentuated. Irregularities of cardiac rhythm were not more frequent postoperatively, than they had been prior to surgery. However, surgery was followed by a marked decrease of right axis deviation and of EKG signs of right ventricular hypertrophy. Pulmonary function studies revealed a slight decrease of vital capacity and of maximal breathing capacity. These results are favourable compaired to medically treated groups of patients as described in the literature. It is concluded, that even in later adult age the atrial septal defect as a rule is an indication for surgery.