The Journal of thoracic and cardiovascular surgery
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The modified Blalock-Taussig shunt, interposing an expanded polytetrafluoroethylene graft between the subclavian and pulmonary arteries, was performed in 30 neonates with a mean age of 8.8 days and a mean weight of 3.14 kg. Underlying lesions included severe tetralogy of Fallot or its variant (N = 10), transposition complex (with pulmonary stenosis or atresia) (N = 6), single ventricle equivalents (with pulmonary atresia or stenosis) (N = 9), and pulmonary atresia with intact ventricular septum (N = 5). The mean preoperative arterial oxygen tension prior to prostaglandin E1 therapy was 29.5 torr. ⋯ The ratios of the diameter of the right pulmonary artery and pulmonary valve anulus to that of the descending aorta increased after the operation by 50% (p less than 0.001) and 52% (p less than 0.05), respectively. Our experience indicates that the modified Blalock-Taussig shunt has an excellent function, offers several technical advantages, and lacks most of the drawbacks of other systemic-pulmonary artery shunts. It may be the shunt of choice in patients less than 1 month of age.
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J. Thorac. Cardiovasc. Surg. · Nov 1984
Comparative StudyEarly and late risk of aortic valve replacement. A 12 year concomitant comparison of the porcine bioprosthetic and tilting disc prosthetic aortic valves.
Aortic valve replacement was performed in 912 consecutive patients from January, 1972, to January, 1983. The 616 male and 296 female patients, whose ages ranged from 16 to 95 years (mean 60.6 years and median 63 years), received 663 bioprosthetic valves and 249 tilting disc valves. A higher incidence of Functional Class IV heart disease and ascending aortic aneurysms was noted in the group receiving the tilting disc valve. ⋯ At 108 months, the probability of freedom from thromboembolism was 85% +/- 3% after bioprosthetic valve replacement and 83% +/- 3% after replacement with a tilting disc valve (p = NS). The probability of freedom from hemorrhage at 108 months was 98.6% +/- 7% for the bioprosthetic valve group and 89% +/- 2% for the tilting disc valve group (p less than 0.001). The valve thrombosis rate was 0.34% per patient-year for the tilting disc valves and 0.07% per patient-year for the bioprostheses.(ABSTRACT TRUNCATED AT 400 WORDS)
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J. Thorac. Cardiovasc. Surg. · Oct 1984
T-lymphocyte analysis in the early diagnosis of adult respiratory distress syndrome.
Adult respiratory distress syndrome occurs concomitantly with a number of clinical conditions but has no known cause. At present, there is no generally acceptable method for establishing the early diagnosis. In the course of studying immune aberrations by means of monoclonal antibody staining and fluorescence-activated cell sorting in injured patients, we noted an apparent specific T-lymphocyte response to this syndrome in one patient. ⋯ When the patient recovered, the helper/suppressor ratio rose to above 3.0. T-lymphocyte analysis offers a promising means of evaluating patients considered highly susceptible to adult respiratory distress syndrome, i.e., victims of massive trauma. Further studies will be required to fully elucidate this possibility.
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J. Thorac. Cardiovasc. Surg. · Oct 1984
Late results after Starr-Edwards valve replacement in children.
Selection of types of prosthetic heart valves for children remains controversial. The case histories of 50 children surviving valve replacement with Starr-Edwards prostheses between 1963 and 1978 were reviewed to evaluate the long-term performance of mechanical valves. The 31 boys and 19 girls ranged from 6 months to 18 years in age (mean 10.4 years); 19 patients had had aortic valve replacement, 24 patients had had mitral valve replacement, and one patient had had both. ⋯ At 10 years postoperatively, 66% +/- 15% of patients who had had aortic valve replacement and 91% +/- 6% of those who had had systemic atrioventricular valve replacement were free of thromboembolism. The excellent long-term survival, absence of mechanical failure, and relatively low rate of thromboembolism with this prosthesis contrast with our experience with biological valves, in which 41% of children required reoperation in 5 years. Currently, mechanical valves, such as the Starr-Edwards prostheses, are our preferred valves for pediatric patients.