Thoraxchirurgie, vaskulare Chirurgie最新文献

With the growth of traffic density and the spread of thoracic surgery, the clinical picture of the chylothorax can be observed with increasing frequency. Above all, the spontaneous or symptomatic chylothorax presents diagnostic problems, since, in about 70% of the cases, it only represents the concomitant symptom of a malignant tumor. Only after exact diagnostics and the exclusion of a malignant primary disease can one be content with the cursory diagnosis of an idiopathic chylothorax. However, this requires strict postoperative control and observation of the patients. Two patients are presented in whom the genesis of the chylothorax still remained unclear 3 1/2 years after the successful ligature of the thoracic duct.

From 1958 to 1975, 309 pts. were operated on for pulmonic stenosis (PSt) with intact ventricular septum. The lesion was of the isolated valvular type in 81,5%, of the infundibular type in 9,1%, and of the combined type in 9,4%. A closed transventricular valvulotomy (Brock) was performed in 33 cases, primarily in infants. 130 pts. underwent transarterial valvulotomy in inflow occlusion, and 146 pts. were operated with the aid of extracorporeal circulation. Hospital mortality was 3,9%. All three operating methods showed almost identical early results, whereas the long-term results indicated a superiority of the open techniques. The results were less satisfying in pts. more than 20 yrs. of age than in younger ones. In 10 cases (3,4%) follow-up revealed recurrent PSt requiring re-operation, mainly because of persisting infundibular hypertrophy and markedly thickened (dysplastic) valve cusps.--Indications for the different surgical techniques are discussed on the base of the results.

In study of screw-dense-fixation-ring method in 15 cases of a dog's femoral artery, end to end, was reconstructed. The anastomoses is achieved by vessels of 3 - 6 mm diameter. Within a period of 1 - 6 months post-operatively, average of 3 months, angiographic control of all cases showed no complications such as aneurysm or stricture. The construction of screw-dense-fixation-ring seems to give a considerable result, because the power which is keeping the rings together, can be controlled.

We report about clinical experiences with the cardioplegia according to Bretschneider combined with deep selective hypothermia of the heart in 44 patients. Before, during and after cardioplegia we made biopsies from the left ventricle of 6 patients for electronmicroscopical examinations. Besides the mitochondrial changes already known we saw a break-down of the nexuses. We discuss the importance if these changes for the action of the cardioplegia. Both changes seemed to be reversible. The clinical results and the immediate and later postoperative follow-up demonstrate, that with the described technique a good myocardial protection can be done. This procedure allows operating with a low risk at a completely arrested and relaxed heart until 130 minutes.

Drainage of right pulmonary vein into the coronary sinus. A case of anomalous drainage of the right pulmonary vein into the coronary sinus in a boy of 6 years is presented. There was no associated atrial septal defect. Flow from the right pulmonary vein was directed into the left atrium by using a teflon patch, while maintaining coronary venous return to the right atrium.

Among a total of 6000 patients of the Herzchirurgische Klinik of the University of Munich, 16 patients had an aneurysm of the sinus of Valsalva. Mostly, this was localized in the right sinus, less often in the non-coronary sinus, and only in one case in the left sinus. In 9 patients the aneurysm had ruptured into the right ventricle or into the right atrium. In 2/3 of the cases the aneurysm was associated with a VSD or an acquired malformation of the aortic valve. The diagnosis in part was based on the typical history with a sudden begin of cardiac symptoms secondary to rupture of the aneurysm; however, the most useful diagnostic procedure was the heart catheterization including an angiogram of the aortic root. Surgical treatment led to good early and late results; there was a low operative risk, and complications were rare; however, the prognosis may be less favorable in the presence of an acquired malformation of the aortic valve.

Thrombocyte levels of patients undergoing open heart surgery were studied to compare effects of a bubble with a membrane oxygenator. Loss of platelets, which is not explained by hemodilution, is smaller in membrane oxygenation and normal level of platelets is readily established postoperatively compared to conventional bubble oxygenation.

Report about successful extraction of cutoff embolised venous katheter from V. jugularis with help of a SIMMONS-catheter. Further possibilities of use of superselective arteriography catheters in this connection are mentioned.

An electromagnetic blood flow cuff probe was implanted up to 4 days in 50 patients to control basal blood flow through a femoro-popliteal vein graft. Patent grafts showed increasing blood flow due to hyperemia with maximum on the 2. p. op. day. The level of the postoperative hyperemia and the increase of blood flow caused by intraarterial papaverine injection during operation were in the same range. The method and the extension of analgesia influenced the degree of postoperative hyperemia. Pain and blood loss diminuished graft flow. Patients with epidural block and sufficient blood volume produced a significant higher graft flow than patients with morphine analgesia. 2 patients had early occlusion of the graft, 2 others showed occlusion at the distal anastomosis. These complications could be easily detected by blood flow measurement and were successfully corrected in two patients. Moreover, electromagnetic postoperative blood flow control may be helpful in patients with proximal a.v. shunt for hemodialysis.

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.