Cardiovascular diseases最新文献

Four widely used bubble oxygenators-the Optiflo I, the Bentley Q 200 A, the Harvey 200, and the Shiley 100 A-were tested and compared in 182 patients undergoing cardiac valve surgery. Fifty-six cases were performed with normothermia and 126 cases incorporated mild hypothermia (28-30 degrees C). There was no significant difference in the average age of the patients (51 yrs) or the perfusion time (60 min). All components of the extracorporeal circuit were identical, and anesthetic regimens and surgical techniques were also similar. In this study, the Shiley 100 A oxygenator was found to be the most suitable for cases requiring mild hypothermia and was generally considered to be the oxygenator of choice.

Thirty-one hearts with aortic arch obstruction and patent ductus arteriosus were examined with special reference to associated cardiac anomalies. Six presented with complete interruption of the aortic arch, four with atretic isthmus, twelve with coarctation, and three with tubular hypoplasia. Associated cardiac anomalies were divided into two main groups: (1) septal defect with left-to-right shunt, and (2) left ventricular inflow and/or outflow obstruction. A high incidence (9/19=47.4%) of ventriculo-infundibular malalignment type of ventricular septal defect with subaortic stenosis was observed. Associated cardiac lesions that reduce blood flow in the aortic arch during fetal life may be responsible for poor development of this structure.

Two cases of coronary arteriovenous fistulae are reported. In the first case, the right coronary artery (RCA) drained into the right ventricular outflow tract, and the distal RCA filled through a branch of the left anterior descending coronary artery. In the second case, the RCA drained into the right atrium and filled through a branch of the left circumflex artery. The fistulae were closed with subcoronary mattress sutures that preserved the continuity of the native circulation.

A 23-year-old man with a previous ventriculo-atrial shunt for a pinealoma developed a febrile illness and heart murmur. The condition was thought to be caused by subacute bacterial endocarditis. Further investigation, however, revealed a mycotic left pulmonary artery aneurysm, which was treated by means of a left pneumonectomy with cardiopulmonary bypass. Such an aneurysm represents yet another complication of ventriculo-atrial shunting for hydrocephalus.

Pulmonary paragonimiasis is caused by the presence of the oriental lung fluke, Paragonimus westermani, within the lung parenchyma. The disease is indigenous to Korea. In a retrospective review of operative cases from 1972 through July 1979 at the National Medical Center in Seoul, Korea, eleven cases were analyzed. The mean age of the patients was 27 years, and all had a history of ingesting raw crustaceans. Diagnosis was based on history, positive skin test, and radiographic findings. The patients were treated with bithionil before undergoing surgery for severe pleural or pleuroparenchymal lung disease. There was one operative death. Long-term follow-up from 6 to 84 months indicated satisfactory results in ten patients. Our experience with this clinical entity forms the basis of this report.

Complete atrioventricular heart block (CAVB) most commonly occurs as a complication of cardiac surgery. We report the development of CAVB in an 8-year-old girl with endocardial cushion defect (ECD) who had not undergone a cardiac operation. Although this is the first report of acquired non-surgical CAVB in a child with ECD, we believe that the development of CAVB in patients with unoperated ECD occurs more commonly than is usually realized. An increased awareness of this possibility will allow expedient diagnosis, which is essential to proper treatment. In most cases, the implantation of a permanent ventricular pacemaker will alleviate congestive heart failure or prevent sudden death.

Over a 2-year period, 19 patients whose autologous saphenous veins were either unsuitable or unavailable underwent myocardial revascularization with saphenous vein allografts (SVAs) at our institution. All SVAs had been preserved in 98% glycerol at room temperature for at least 3 weeks (average, 7 weeks); before use, they were rinsed with saline and antibiotic solution. One operative death (5.2%) and three late deaths (16.6%) occurred. Fourteen of the long-term survivors have been observed for 24 to 48 months (average 32.2 months) postoperatively. Nine are asymptomatic, whereas four complain of angina, and one reports exertional dyspnea with-out chest pain. Only three patients have been restudied (7, 10, and 18 months after surgery, respectively); in each of these patients, angiography has shown occlusion of all SVAs. However, histologic examination of glycerol-preserved SVAs has not revealed pathologic changes that would suggest potential graft failure. Despite fairly satisfactory clinical results, preliminary hemodynamic data indicate that glycerol-preserved SVAs are unsuitable for myocardial revascularization in the absence of autologous saphenous veins.

For the repair of ventricular septal defect, we have devised a technical modification that makes use of a mushroom-shaped patch and a left ventricular buttress. Since 1972, we have applied this technique in 97 patients, most of whom had moderate to severe hypertension before surgery. Twelve early deaths and one late death resulted. The major complications included two cases of permanent heart block, nine cases of temporary heart block, and two suspected cases of residual shunting. The method has proven effective in preventing a recurrence and in lowering the incidence of surgically produced heart block.

Although the Davila-Sierra mitral valve prosthesis was removed from the market nearly a decade ago, a number of patients still have this valve in place. We recently studied the echocardiographic features of a malfunctioning Davila-Sierra mitral valve prosthesis. Abnormalities that suggested improper functioning of the prosthesis included a markedly delayed poppet opening and an early diastolic hump believed to represent motion of the mitral annulus. Previously described echocardiographic indications of dys-function were not observed in our patient. We report the first known echocardiographic evaluation of a Davila-Sierra prosthesis.