The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Mar 1977
Case ReportsRetention of pacemaker electrode complicated by Serratia marcescens septicemia. Removal with total cardiopulmonary bypass.
A case in which Serratia marcescens septicemia complicated the insertion of a transvernous pacemaker unit is reported. Appropriate antibiotic therapy and removal of the pacemaker electrode are two essential steps to achieve a complete cure in this stimulation. Open cardiotomy with total cardiopulmonary bypass provides a safe approach for withdrawal of an incarcerated electrode and is justified because of the lethal potential of systemic Serratia infections, particularly those superimposed on intracardiac prostheses.
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J. Thorac. Cardiovasc. Surg. · Feb 1977
Effects of coronary bypass surgery on the electrical activity of revascularized myocardium. Immediate and early postoperativeobservations.
The effect of myocardial revascularization on bipolar epicardial electrograms was recorded with fixed wire electrodes from revascularized left ventricular sites and from control sites on the right ventricle. Studies were performed during and after surgery in 19 patients undergoing aorta-coronary bypass grafting for occlusive coronary artery disease and in 6 additional patients having aortic valve replacement for isolated aortic valve disease. In the latter 6 patients, neither left nor right ventricular electrogram voltage changed immediately following aortic valve replacement; however, left ventricular electrogram voltage gradually decreased for 5 days postoperatively. ⋯ These observed changes did not correlate with preoperative hemodynamics, number of grafts, graft flow rate, aortic cross-clamp time, cardiopulmonary bypass time, and the early postoperative course. These preliminary observations suggest that coronary bypass grafting does affect the electrophysiological state of the revascularized myocardium. However, the mechanism by which it occurs and its clinical implications remain to be determined.
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J. Thorac. Cardiovasc. Surg. · Dec 1976
Individual responses to heparinization for extracorporeal circulation.
It has been proposed that wide variations in individual response to heparin lead to deficiencies in popular heparinization protocols for extracorporeal circulation (ECC). Thirty-nine patients undergoing open cardiac operations with ECC were anticoagulated with the heparinization protocol in use at St. Thomas' Hospital. ⋯ The total dose of heparin declined because BART monitoring allowed elimination of incremental heparin doses up to 180 minutes of ECC. Adequate reversal with protamine was achieved in all patients regardless of response to herparin. Alternative approaches for heparinization for ECC can be developed with the aid of rapid tests of the intraoperative coagulation state.
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J. Thorac. Cardiovasc. Surg. · Sep 1976
Arterial prosthesis of microporous expanded polytetrafluoroethylene for construction of aorta-pulmonary shunts.
A new arterial prosthesis made of polytetrafluoroethylene (OTFE) was evaluated in 10 infants with complex cyanotic congenital heart disease. All grafts used were 4 mm. in diameter and varied in length from 0.8 to 6 cm. The grafts were anastomosed to the main pulmonary artery or its bifurcation in 8 infants and to the right and left pulmonary arteries in one each. ⋯ The PTFE graft and/or anastomoses will not grow with the growth of the child and therefore may not accommodate growth by increased flow. This may prove to be a limiting factor in its long-term use in fants. We reserve the use of these grafts for infants with complex cyanotic defects undergoing emergency surgery or in older children in whom a conventional shunt is not possible or a previous shunt has failed.
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J. Thorac. Cardiovasc. Surg. · Sep 1976
Immune reactivity in primary carcinoma of the lung and its relation to prognosis.
Detailed studies of immune reactivity were performed in 154 patients with primary lung cancer, 20 patients with benign thoracic lesions, and 109 healthy persons. Reactions to the 2,4-dinitrochlorobenzene (DNCB) skin test were postive in 73 per cent of patients with lung cancer and all (100 per cent) of the patients with benign disease (p less than 0.05). The incidence of DNCB reactions was 78 per cent for Stage I and II cancers (37 patinets), 73 per cent for resectable Stage III cancer (22 patients), and 66 per cent in patients with unresectable or inoperable Stage III cancer. ⋯ Svrvival curves were plotted in patients with Stage III disease according to the responses to three immune parameters: DNCB, absolute lymphocyte count, and PHS stimulation. Although patients with normal reactions generally had better survival rates, PHA responses showed the most significant correlation to survival. These tests support the usefulness of immune testing as an additional parameter of assessing biological risk in patients with primary lung cancer.